Whooping Cough

Whooping cough is highly contagious; it usually affects infants and young children although adults can sometimes develop the condition. The condition is caused by bacteria, Bordetella pertussis. It is spread by droplets when an infected person coughs or sneezes. It is called whooping cough because the main symptom is a hacking cough often followed by a sharp intake of breath that sounds like a 'whoop”.

the selection of patients for pneumothorax therapy; moreover, its inception calls for continuous supervision. The technique of the induction of a pneumothorax is readily acquired. Bentley regards this as a misfortune, for he thinks that the method may be unwisely used; he adds that it is "only on a wide knowledge of the disease in all its aspects that correct selection can be based". The question is open to argument. An inexperienced practitioner will surely send his patient to an expert if he thinks that pneumothorax therapy should be considered. If he undergoes a course of training in this treatment he will realize its limitations and seek advice whenever he is in doubt. Danger might arise if an uninstructed practitioner, fired only by his enthusiasm, were to look on himself as fit to introduce air into the pleural cavity of the tuberculous. Thus arises another point. Bentley states that the London County Council has appointed a panel of five thoracic surgeons, and in addition to equipping theatres at certain of its sanatoria and special hospitals for tuberculosis, has provided thoracic surgical units at two of its general hospitals. These experts will be extremely useful, especially when incomplete collapse only can be obtained. Whether there is need for some such arrangement as this in Australia is a question that may be debated.
1 The Quarterly Journal of Medicine, July, 1936. attention to the seriousness of the condition. Smith's review of recent work in this disease is such a concise and interesting contribution that the attention of medical practitioners may well be drawn to the more important of his statements.
In dealing with any infectious disease it is essential to determine the incubation period. Unanimity has not been reached in regard to this point. Stocks concluded that the incubation period might be as short as three days, but that it was usually a week; Stocks came to his conclusion from an analysis of London figures. Funck-Hellett, after observing seven epidemics in a children's home, believed the incubation period to be longer-ten to twenty days. Smith's findings support those of Stocks, but he wisely adds that the insidious onset makes it difficult to determine precisely when the disease manifests itself. In two boys, reported by H. and E. J. Macdonald, the disease was reproduced experimentally, and the incubation period in both instances was seven days. Infection is usually spread by sufferers who are in the early stages; it is also admitted that carriers exist.
The classical description of whooping cough is that of the worst cases; it must, however, be remembered that the type in which neither whooping nor vomiting occurs, is very common. Smith states that there can be no reasonable doubt that the causative organism of whooping cough is Hremophilus pertussis, more commonly known as the Booilllus pertussis of Bordet and Gengou. All bacteriologists will not agree with this statement; many believe that the responsible agent is a virus, and that the Bacillus pertussis is a secondary agent. Smith states that the number of those who hold this belief is rapidly diminishing. He points out that the serum of patients convalescent from whooping cough contains complement fixation substances against Bacillus pertussis, and that the disease has been reproduced in human volunteers.
Diagnosis is simple when the condition is well established; difficulty sometimes arises in the early stages.
The cough-plate method of diagnosis described by Gardner and Leslie is, in Smith's opinion, a reliable and fairly quick confirmatory test. He also uses the findings on examination of the cough-plates to show that the wisdom of the procedure adopted in England in regard to the time during which quarantining of affected children should be carried out. The medical officers of Schools Association advises that patients should be quarantined until the characteristic spasmodic cough and the whooping have ceased for at least two weeks, or, in cases of persistent whooping, for not less than four weeks from the commencement of the spasmodic cough. The Ministry of Health and the Board of Education jointly advised a quarantine period of six weeks from the commencement of the cough. In Denmark, children are allowed to return to school four weeks after the commencement of the spasmodic stage.
From the practical point of view, most interest will probably centre round Smith's views on vaccine and its uses. Widely divergent opinions on the efficacy of vaccines used for prophylaxis or treatment have been expressed in this and probably every other medical journal that deals with diseases of children; the truth is hard to discover. Smith points out that work on the bacteriology of whooping cough has recently been elaborated so that it is possible to classify the organisms into four phases, all of which are interchangeable by cultural methods, with the possible exception of Phase IV organisms, which are old bacilli, long accustomed to growth on agar. Phase I organisms are those best suited for the preparation of vaccines-these are indeed stated to be necessary for the preparation of useful vaccines. Smith recommends prophylactic vaccination with these organisms in doses of thirty to eighty billions at an early age, preferably between six months and two years of age. He can find no evidence whatever that vaccines are of any value in treatment "except possibly in the earliest stages". He also discusses the use of human convalescent serum.

LATE INFECTION FOLLOWING .THE USE OF PINS AND WIRES IN BONES.
THE use of skeletal traction in the treatment of fractures by hooks, pins and wires, has yielded results that were seldom attainable by the old methods. Hooks, pins and wires have become part of the equipment of every surgeon who has to treat fractures, and in certain circumstances their use has become obligatory. At first sight, the insertion of a pin or a wire into a bone seems a simple matter, and doubtless it is. In reality it is the after-treatment that is simplified, for the fractured bone is, as a rule, controlled much more easily than by other methods. The opening of the cancellous tissue of a bone by the insertion of a metal pin or wire is a serious undertaking, and experienced surgeons have learned that cancellous tissue of bone must be treated with respect. For those who have not yet learned this from their own experience, it may be well to draw attention to a communication by S. L. Haas, of the Shriners Hospital for Crippled Children at San Erancisco.! Haas's paper was read before the Section on Orthopeedic Surgery at the annual meeting of the American Medical Association last May. He reported 'three cases in which atent infections called for operation at periods varylll.g from two to th.ree years after the use of pins and WIres. All the patients were children.
Haas points out that though pins and wires are inserted under strict aseptic technique, the tract is potentially infected. Wires and pins have an external opening which in itself acts as a drain and gives some protection. On the other hand the extern~l opening serves as a portal of entry for bacteria. Fortunately, after the insertion of the wire or pin a defence barrier of granulation tissue is formed along the course of the wire or pin, and 1 The Journal of the American Medical A880ciation, November 14, 1936. helps to inhibit infection. Haas points out that the prevention of motion is important, so that this barrier shall not be injured and new avenues opened up for the invasion of bacteria. For the same reason pins or wires should be removed with strict aseptic precautions and with a minimum of trauma. After removal of the wire, the soft parts heal before the bone, and a sealed-off, firm, non-collapsing channel is left in the bone. Some dormant infection may remain, to light up at a later date. In Haas's cases pathological examination revealed a lowgrade infection.
The obvious conclusion is that skeletal traction by pins or wire should not be used if the fracture can be as effectively treated by other means. THE title of a recent contribution by the Professor of Biochemistry at Oxford, R. A. Peters, "The Biochemical Lesion in Vitamin Hi Deficiency'? probably forecasts the nature of many medical articles of the future. A new type of analysis is now being undertaken by modern biochemical research, which is comparable in detail and in exactitude in the chemical field to that of present-day histology in the structural. Biochemical investigation into the functional changes of individual cells is possible only when a strictly uniform tissue is available for observation. For this reason, and because of its practical significance, it is natural that most progress has been achieved by study of the cancer cell, especially its glycolysis.
Peters and his staff have striven to reduce to exact biochemical terms the pigeon test for vitamin B l • It seems that the chance observation of the relation of beri beri to vitamin Bi deficiency, which was described to us in the physiological classroom, has now been adopted as a standard means of estimating B 1 content of a diet or the potency of antineuritic preparation. Peters points out that a distinct difference is observable between the rates of cure of acute and chronic symptoms in the affected pigeon. Established leg and wing weakness may take many days to improve, whereas opisthotonus and convulsions respond in under an hour following injection of vitamin B l under the skull. The story of the search for the biochemical lesion responsible for the acute symptoms is an interesting one. Arrest of all vital and chemical change was produced in the brains of affected pigeons by immersing them in liquid air within ten seconds of bodily death. It was then found that the base of the cerebrum contained a relatively greater amount of lactic acid. Lactic acid in excess of normal had previously been reported in the blood of avitaminous pigeons and beri beri patients. The respiration of normal and avitaminous pigeons' brains was next studied with and without the